Inpatient Sr Clinical Coder - Remote

Contract to Hire with 6 to 9 months average time on contract

Position Overview

• Title: Inpatient Senior Clinical Coder
• Type: Contract to Hire
• Work Arrangement: Fully Remote (specific states to be confirmed)
• Focus Areas: Inpatient coding, DRG assignment, and retrospective medical claims review

Key Responsibilities

1. Coding Expertise:
   • Conduct retrospective reviews of medical claims to determine appropriate coding and pricing.
   • Perform diagnosis and procedural coding for inpatient claims with DRG (Diagnosis-Related Grouping) assignment.
   • Serve as a subject matter expert for medical claims coding related to both outpatient and inpatient services.
2. Collaboration and Support:
   • Provide coding-related information to medical directors, providers, peer reviewers, and other stakeholders.
   • Assist non-clinical and clinical staff with coding and retrospective claims review processes.
3. Network and Provider Relations:
   • Act as the designated recipient for factual network provider claim review requests.
   • Develop determination letters as part of the review process.
4. Internal Coordination:
   • Work closely with Claims, Administration, Program Integrity, Quality Management, and subcontractors to ensure accurate coding and claims processing.

Requirements

• Experience:
  • Strong background in inpatient coding and comprehensive understanding of DRG coding.
• Certifications:
  • HRIT (Health Record Information Technology)
  • HRIA (Health Record Information Administration)
• Leadership:
  • Ability to work under the direction of a DRG Supervisor or designee, demonstrating both independence and collaborative skills.

Additional Notes

• Approved states for remote work to be specified by the employer.
• This position is critical to ensuring compliance and accuracy in coding practices, supporting both operational and provider-related activities.